Nonoperative Management of Types II and III Odontoid Fractures: The Philadelphia Collar versus the Halo Vest

Polin, Richard S.; Szabo, Tom; Bogaev, Christopher A.; Replogle, Robert E.; Jane, John A.

doi:10.1227/00006123-199603000-00006

Cited by 23 publications

(21 citation statements)

References 24 publications

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“…Some authors consider halo thoracic bracing is preferable to cervical collars [26] while others have abandoned this Halo vest treatment [43], or found them poorly tolerated by the patients older than 75 years of age [36] with a questionable efficacy to prevent in vivo motion [3]. Similar to Polin and coworkers we favored the use of the rigid cervical orthosis in the majority of cases [39], given the lack of significant difference in the need for late surgical procedures and improved patient comfort with cervical orthosis and elimination of the risk of halo-related complications.…”

Section: Discussionsupporting

confidence: 56%

Radiographic analysis of type II odontoid fractures in a geriatric patient population: description and pathomechanism of the “Geier”-deformity

et al. 2011

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Introduction Type II odontoid fractures are one among the most common cervical spine fractures in the elders. We reviewed a consecutive series of patients, aged 65 years and older, presenting to our institution with type II odontoid fractures. Our analysis focused on the radiographic outcome, union rate and the development of cervical spine postural deformity. Patients/methods Indications for surgical treatment (OP) included displaced or unstable injuries. Stable, nondisplaced injuries or patients with significant co-morbidities were treated nonoperatively (non-op). Results Ninety patients (50 f, 40 m) with an average age of 83 years (65-101) were identified. 31 (34.4%) patients were received OP and 57 (63.3%) were received non-op treatments. The hospital length of stay was significantly longer after OP (mean 10 days vs. 6 days non-op) treatment (p = 0.007). At follow-up, higher union rates were noted in the OP (76.2%) than in the non-op group (58.3%). Conclusion We observed a characteristic cervical spine deformity in geriatric patients with type II odontoid fractures, and have termed this the ''Geier-deformity''. Clinical findings of the deformity include sagittal imbalance and kyphosis of the lower cervical spine.

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Section: Discussionsupporting

confidence: 56%

Radiographic analysis of type II odontoid fractures in a geriatric patient population: description and pathomechanism of the “Geier”-deformity

et al. 2011

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“…High nonunion rates after nonsurgical treatment have been previously described 5,[21][22][23] . Lennarson et al 24 performed a case-control study that identified age as a significant predictor of nonunion after halo immobilization.…”

Section: Discussionmentioning

confidence: 87%

Functional and Quality-of-Life Outcomes in Geriatric Patients with Type-II Dens Fracture

Vaccaro¹,

Kepler²,

Kopjar³

et al. 2013

The Journal of Bone and Joint Surgery

125

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“…However, we have chosen not to use this treatment for two main reasons. Firstly, the frequency of non-union is unacceptably high, especially in the elderly population, where 25-30% may develop non-union [13,20]. Secondly, elderly people tolerate the halo vest poorly [13,19].…”

Section: Discussionmentioning

confidence: 99%

Odontoid fractures: high complication rate associated with anterior screw fixation in the elderly

Andersson¹,

Rodrigues²,

Olerud

2000

European Spine Journal

201

122

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IntroductionFractures of the odontoid process of the axis have been the subject of many investigations, but most articles do not consider the biological impact of age. Few publications cover the subject in the elderly population, although odontoid fractures are the most common fractures of the cervical spine in this age group. There is still a lack of agreement on the best method of treatment among patients over 65 years of age. Conservative treatment carries a high risk of developing non-union [15,19] as does halovest treatment [8]. Posterior C1-C2 fusion according to Gallie has long been the method of choice. The Gallie technique, however, is not biomechanically optimal and has a failure rate of 1/5 [9]. By adding transarticular screws the mechanical situation was improved [14,16]. Recently, the anterior screw technique according to has gained increased popularity. In most reports, younger and older patients have been grouped together. Few publications have examined the results explicitly in the elderly population. Berlemann and Schwarzenbach [5] advocated the anterior screw technique in the elderly.The present study is a review of a consecutive series of odontoid fractures in patients over 65 years of age treated at our department between 1988 and 1994. The results of anterior screw fixation, posterior C1-C2 fusion, and conservative treatment are compared. Materials and methodsThe series consists of 29 consecutive patients (18 women) with a mean age of 78 (66-99) years with odontoid fractures treated at our department between 1988 and 1994. Patient demographics and results are presented in the Table 1. Twenty-four of the fractures were Abstract This study is a retrospective analysis of patients older than 65 years with odontoid fractures. The series consisted of 29 consecutive patients with odontoid fractures (18 women, mean age 78, range 66-99 years). Twenty-six patients were neurologically intact, Frankel E, whereas three had neurological symptoms: two Frankel D and one Frankel C. Eleven patients were treated with anterior screw fixation according to Böhler, seven with a posterior C1-C2 fusion. Ten patients with either minimally displaced fractures or with complicating medical conditions were treated conservatively. At follow-up, 7/7 patients with posterior fusion had healed without any problems, whereas 8/11 patients treated with anterior screw fixation, and 7/10 conservatively treated patients were either failures or had healed, but after a complicated course of events. We conclude that anterior screw fixation according to Böhler is associated with an unacceptably high rate of problems in the elderly. Probable causes may be osteoporosis with comminution at the fracture site, or stiffness of the cervical spine preventing ideal positioning of the screws. As non-operative treatment also often fails, the method of choice seems to be posterior C1-C2 fusion.

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Nonoperative Management of Types II and III Odontoid Fractures: The Philadelphia Collar versus the Halo Vest

Cited by 23 publications

References 24 publications

Radiographic analysis of type II odontoid fractures in a geriatric patient population: description and pathomechanism of the “Geier”-deformity

Radiographic analysis of type II odontoid fractures in a geriatric patient population: description and pathomechanism of the “Geier”-deformity

Functional and Quality-of-Life Outcomes in Geriatric Patients with Type-II Dens Fracture

Odontoid fractures: high complication rate associated with anterior screw fixation in the elderly

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